MEDICARE: OKCITY RX, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy		OK

General Provider Information

NPI Number	:	1588169692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKCITY RX, LLC

Provider Business Mailing Address
First Line	:	3300 NW 56TH ST STE 101
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4530
Country	:	US
Telephone Number	:	405-451-2333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 NW 56TH ST STE 101
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4530
Country	:	US
Telephone Number	:	214-421-2210
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW LESZCZYNSKI
Credential	:
Telephone Number	:	405-451-2333

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	08/14/2020

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Directions to “OKCITY RX, LLC ” Practice Location

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